A giant popliteal artery pseudoaneurysm 24 years after gunshot trauma: A rare delayed vascular complication

Popliteal artery pseudoaneurysms are uncommon and can present as delayed complications of trauma, with clinical symptoms that may not appear until many years after the initial injury. This report describes a remarkable case of a giant popliteal artery pseudoaneurysm diagnosed 24 years following a gunshot wound. The patient, a 71-year-old male, presented with a palpable swelling and restricted movement in the left popliteal region. Notably, he had sustained a gunshot injury to the same limb more than two decades earlier, during which no immediate vascular complications were identified. Diagnostic imaging played a crucial role in this case. Doppler ultrasonography and computed tomography (CT) angiography revealed a large pseudoaneurysm measuring 12 cm in diameter, accompanied by erosion of the adjacent tibial bone. Surgical exploration confirmed the diagnosis of a popliteal artery pseudoaneurysm. The patient underwent successful vascular reconstruction using an autologous saphenous vein graft, which restored arterial continuity and limb function. This case highlights the diagnostic challenges posed by late-presenting popliteal artery pseudoaneurysms. Because symptoms can remain latent for years, these vascular abnormalities may be overlooked or misdiagnosed, particularly when there is a long interval since the initial trauma. The findings underscore the importance of prolonged and vigilant follow-up in patients who have sustained penetrating limb injuries, as pseudoaneurysms can develop decades later. Early diagnosis, facilitated by appropriate imaging modalities such as Doppler ultrasound and CT angiography, is essential for effective management. Prompt surgical intervention can prevent serious complications, including rupture, limb ischemia, and chronic pain, ultimately improving patient outcomes.